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Breast Lifts - Mastopexy

 

                                   Breast Lift Surgery - Mastopexy

                                               Licensed image for CosmeticSurgeryForums.com

 

Key reasons for changes in breast shape:

  • Age

  • Hormonal fluctuations

  • Pregnancy

  • Weight loss and gain

  • Genetics

There really is no one breast skin or body type that causes the breast to sag. It is quite simply the changes in a woman’s breast volume that contributes to the skin stretching and with subsequent sag.

 

Breast lifts address the two main causes of drooping:

  • Stretched ligaments that can no longer support the breast.

  • Slack skin that does not bounce back after pregnancy or weight fluctuations.

Sagging which is called “ptosis” results in flattened breasts with an elongated shape and a nipple/areola complex that is pointed downward.  In profile views of more of a pronounced case of ptosis, the nipple/areola complex of an unsupported breast hangs visibly lower than the breast crease. When breasts sag to this extent, the only thing to make the breasts appear more visibly aesthetic is wearing a good supportive bra – so that the breasts can appear more normal.

The best technique for a woman’s breast lift is predicated on several important factors.  Shape, location of scars, quality of scars, longevity, sensation of the nipple/areola complex and preservation of lactation are among the several issues a plastic surgeon must consider.  Equally important is the degree of sagging, the elasticity of your skin, and the amount of excess skin your plastic surgeon plans to remove.

To correct sagging and create a perkier breast, incisions are made to sculpt the breast to a new shape and position, reduce excess skin and raise the nipple/areola complex. Through these incisions – excess skin is removed; the nipple/areola complex is moved to a more youthful position, and in some cases the areola is made smaller to better match the proportions of the new breast shape.  Incision patterns are typically the same as those used for breast reductions

A breast lift does not change the amount of breast tissue a woman has, but it does change the shape and position which can affect overall breast size. 

The new shape and position of your breasts will be visible immediately after surgery, but the new look will settle a few weeks post-operative. Breast lift surgery is the only permanent way to restore a youthful body contour to the breasts.  For most patients, a breast lift is a one time procedure, but if another lift is necessary, the same incisions can usually be used.

 

                               Surgeon suturing up incision for breast augmentation

                                                 Licensed image for CosmeticSurgeryForums.com

 

 

Important Facts to know if you are a candidate for a Breast Lift:

  • Knowing the distance from the base of the neck to the nipple, normally this is around 18 -22 centimeters (cm). If this measurement is more, you will need a lift.

  • The nipple should be positioned in the center of the breast mound; normally this is between 7.5cm to 8 cm. from the breast fold.

  • The nipple/areola complex should not be pointing downward.   

  • The nipple/areola complex is never below the breast fold.

  • Is one breast nipple/areola complex positioned lower on one side only.

  • The breasts should be symmetrical in size.

 

 

 

 

The degree of ptosis or sag your breast tissue has, determines the type of breast lift that will be indicated.

                                          Degree of Ptosis for Breast Lift Surgery

                              Nipple positions to see if a breast lift will be indicated

 

  • The image at the left is a good candidate for breast augmentation. 

  • The second image is marginal candidate for breast augmentation. Quite possibly a implant will be all that a patient might need to bring the slight ptosis up enough.

  • The third and fourth images would require some form of a breast lift.  A patient with this degree of ptosis or sag are also candidates for breast implants if they express a desire to be larger; but a breast lift is more than likely definitely needed.

 

 

 

 

There are several lift options that are available to the patient - depending on the amount of ptosis (sag) and of course what lift procedure the plastic surgeon is most comfortable doing.

 

Different Breast Lift Options:

 

A recommended Breast Lift are based on the following criteria:

  • Breast Size

  • Breast Shape

  • Size and position of your Nipple/Areola Complex

  • Breast Sag or ptosis

  • Elasticity of the skin

  • Breasts lack a pleasant shape and firmness

  • If the patient has a breast deformity

  • If the patient wants their breasts to appear "perkier"

  • Asymmetry in the nipples

  • Excess or the amount of extra skin you might have

 

 

 

The Crescent Lift is the least invasive and reserved for those patients who have very little ptosis (sagging). What is involved with this procedure is a crescent-shaped piece of the excess skin is taken from above the nipple, and suturing the tissue higher on the breast mound.

A Crescent Lift is made with a semi-circle incision that can be made on either the top or bottom side of the bottom side of the areola, depending on the amount of lift is needed.  Another incision is made a small distance from the first incision and is made to resemble a crescent shape. 

There is an area of skin that is removed, that once it is taken out, the surgical area appears like a crescent shape.  The plastic surgeon will then pull the opening closed and suture it shut.  More than likely there will be dissolving sutures to hold everything together. Sometimes a permanent suture is needed to ensure a longer lasting result. 

The loose sagging skin is pulled from the three sides of the breast to make the breast mound appear perkier. This procedure is used in conjunction with the peri-areolar incision for breast augmentation, since the incision itself is used for both procedures.

A Crescent Lift removes a small amount of mostly skin and some tissue. Typically the results of this surgery will raise the areola 1.5 to 3 centimeters and the nipple area between 1 to 1.5 centimeters.

This procedure is the least invasive out of all the breast lifts. It also has the shortest amount of recovery time. 

 

Ideally the Crescent lift is used in women with the following:

  • Very minor ptosis

  • Women who have smaller breasts

  • The sagging issues are due to either childbirth, breastfeeding or age

 

        Crescent Lift Incision - Breast Lift Surgery          Crescent Lift Diagram of Crescent Lift Procedure

                      Crescent Lift Incisions                            Crescent Lift Diagram of actual procedure

 

 

 

The Benelli breast lift was developed in the mid 1980's and named after Dr. Louis Benelli. This lift Benelli mastopexy is used for women with mild to moderate breast ptosis or sagging.

Benelli Lift and "Purse String" Sutures

With the Benelli Lift the incision is all around the areola, in which a donut shape piece of tissue is taken away and the tissue is then re-sutured to the edges of the areola. The remaining skin is tightened as the incisions are closed. 

The plastic surgeon commonly uses the purse string method of re-suturing.  

The nipple always stays attached during the procedure.  This "purse string" stitch is a permanent stitch which is placed around the circumference of the skin around the areola. This is done to prevent spreading of the scar. The breast is both lifted and tightened underneath the skin and more than likely this procedure is combined with a breast augmentation.

This is the second least invasive lift and is also reserved for those patients who do not have a lot of ptosis (sagging). This lift will also help those patients who have extra large areolas and want to reduce the size. The scarring from donut/benelli mastopexy occurs around the perimeter of the nipple/areola complex, and is often less noticeable than the vertical scars from the standard technique of a vertical lift/lollipop lift.

 

 

The Benelli Lift is also known as:

  • Donut Lift

  • Peri-areolar Lift

  • Concentric Lift

 

  Benelli Lift Incisions - Breast Lift Surgery          Benelli Lift Diagram of actual procedure

                  Benelli Lift Incisions                                      Benelli Lift Diagram of actual procedure   

                                                                                             Skin is removed and a Pedicle of tissue

                                                                                             remains.  Internal sutures are placed to

                                                                                                       keep the scar from stretching.

 

 

 

 

 

The Vertical Lift is known as:

  • Lollipop Lift

  • Keyhole lift and the

  • Lejour lift

 

This lift is reserved for those patients who have a moderate amount of ptosis (or sagging), and the benelli is not going to be enough. The incision runs around the nipple/areola complex and then straight down to the crease underneath the breast. The goal of breast lift surgery is to minimize scarring as much as possible while creating the best shape to your body type.

If your nipple/areola complex is below the fold of your breast, you will need a mastopexy.  The necessary scarring differs depending upon the degree of sagging/ptosis. A short or "lollipop" scar around the areola and down to the breast fold is engaged to get the best breast shape.

 

 Vertical Lift Incisions - Breast Lift Surgery          Vertical Breast Lift - actual procedure

         Vertical Breast Lift Incisions                                    Vertical Breast Lift actual procedure

 

 

 

 

 

The Full Mastopexy or Full Anchor is also called:

  • “Inverted T Incision”

  • T-Incision

  • T-Scar

  • Inverted T Pattern

 

Known as the oldest and most reliable method of breast lifts - and is the one that is normally needed for a woman going under breast reduction surgery.

 

Full Anchor - Full Mastopexy Procedure - Breast Lift Surgery          Full Anchor / Full Mastopexy Procedure

   Full Anchor/Full Mastopexy Incisions                       Full Anchor/Full Mastopexy Procedure

 

This is the most common used technique for women who have severe ptosis with the nipple/areola complex facing down towards the ground. This is also the most invasive lift done along with sometimes being the difficult with healing. This lift got its name from the way the incisions are placed on the breast mound. 

The incisions start with going the entire circumference of the nipple/areola complex – extends downward towards the crease underneath the breast, and extends the entire way of the crease, resembling an “anchor”.

The nipple/areola complex usually has to be removed and repositioned on the newly lifted breast, as there is usually skin that will be surgically cut away both vertically and horizontally to allow the breast to be moved upward and towards the center of the breast mound. 

 

 

 

                        Incision placement for a Full Anchor Lift

                                 2010 Copyright ADAM, Inc. - Used with permission                                       

                                  Incision Placement with a Full Anchor Lift

 

                                 Anchor Lift Procedure 

                                          2010 Copyright ADAM, Inc. - Used with permission                                

                                                                 Anchor Lift Procedure            

 

                                     Before and After Full Anchor Lift

                                      2010 Copyright ADAM, Inc. - Used with permission

                                               Before and After Full Anchor Procedure

 

 

 

Cost of mastopexy can range from $4,711 (2007 report from the ASAPS) up to $10,000 (if the lift is done in conjunction with an augmentation) - depending on where the plastic surgeon is located, the difficulty of the case, and method he or she might use. 

Most breast lifts are done together with breast augmentation, however there seems to be more plastic surgeons suggesting that the best results for longevity of the lift – is to do the lift first and then schedule the augmentation after a period of several months. 

This is done so that the lift can heal properly without the extra weight of the implants compromising the incisions.  To have this procedure done in a two step method ends up being more costly for the patient, but usually does insure the longevity of the lift.

 

 

 

 

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